Counseling Practice During Phases of a Pandemic Virus. Mark A. Stebnicki

will assist mental health and allied helping practitioners in recognizing, identifying, and assessing critical areas of concern with the intention to initiate case formulation and treatment planning. As noted in many structured assessments of mental health, various physiological characteristics, neurocognitions, thoughts, feelings, emotions, behaviors, and experiences make up the list of symptoms and conditions that are clinically significant. In addition, each diagnostic category considers features in its evaluation of mental health conditions such as development and course, risk and prognostic factors, cultural implications, diagnostic markers, differential diagnosis, and comorbidity.

      Behavioral Health

      The PRRC recognizes the importance of behavioral health as shaped by learning, cognitions, observable actions, emotions, and sociocultural factors. Behavioral health in the PRRC theoretical model primarily focuses on current behaviors in the here and now. Central to behavioral health is the contribution of wellness theories that describe healthy human functioning in multiple life areas. A basic assumption in behavioral health is that people can change, modify, attenuate, mitigate, and anticipate a range of behaviors that impact healthy medical, physical, psychological, psychosocial, occupational, and spiritual health and overall functioning.

Psychosocial Health

      Psychosocial health involves a complex interplay of adjustment and adaptation as they relate to an individual’s medical, physical, psychological, social, emotional, spiritual, educational, career/vocational, and environmental health. Individuals’ collective experiences of adjustment and adaptation vary with regard to attitude and perception, residual functional capacity, preexisting conditions and experiences, and coping and resiliency that manifest during phases of psychosocial adjustment and adaptation.

      Medical/Physical Health

      Medical/physical health involves the complex interplay of neurobiology, physiology, body systems theory, functional capacity, and diagnostic and clinical categories as defined by acceptable standards of practice and treatment by medical health experts. Medical/physical health uses a disease model that is detectable and observable by observation, description, and evaluative technology to establish a medically determinable impairment, disease, or disability.

Theoretical Assumptions of the PRRC Model

      The PRRC helps mental and behavioral health professionals evaluate a variety of mental, behavioral, and psychosocial health risk and resiliency factors related to pandemic viruses. The PRRC model is divided into two separate models—risk and resiliency—each assessed on a 5-point scale. The five-level scales of risk and resiliency assess four categories: mental, behavioral, psychosocial, and medical/physical health. The five levels of resiliency and risk are as follows:

Resiliency Scale	Risk Scale
5 = Excellent Resiliency	1 = Low Risk
4 = Very Good Resiliency	2 = Mild/Slight Risk
3 = Good Resiliency	3 = Moderate Risk
2 = Fair Resiliency	4 = Severe Risk
1 = Poor Resiliency	5 = Extreme Risk

      The model may be adaptable to different settings and can be applied with people of different age groups (e.g., adolescents, young adults, middle-aged adults, older adults). The intent of using the PRRC model is to anticipate and prevent risk behaviors and intervene with individuals who exhibit mental, behavioral, psychosocial, and medical/physical risk factors while simultaneously endorsing and reinforcing various resiliency traits and characteristics during the COVID-19 pandemic disaster.

The theoretical assumptions in the PRRC model are multidimensional and relate to related research and the comprehensive body of work presented in Counseling Practice During Phases of a Pandemic Virus. In addition, the PRRC model has been reviewed and critiqued by a panel of eight experts in disaster mental health response, epidemiology, medical and psychosocial aspects of illness and disability, and applied behavior science. A primary supposition is that individuals exhibit a range of mental, behavioral, and psychosocial responses and adaptations during pandemic disasters on a continuum from excellent to poor resiliency and from low to extreme risk.

      It is hypothesized in the PRRC model that individuals who have tested positive for the COVID-19 virus (or believe they acquired symptoms without having been tested) can range on a continuum of risk and resiliency. Given the unpredictable nature of some variants of COVID-19 among younger and older individuals, the symptoms, course, and prognosis of the disease is not fully known at the time of this writing in April 2021. There are many factors to examine, such as the incidence and prevalence of reinfection, which body systems the virus attacks, and the long-term impacts. Thus, mental, behavioral, and psychosocial health risk and resiliency factors also remain unknown. Some individuals may rationalize “I’ve been around crowds of people and the virus did not kill me, so I must be immune,” giving themselves a false sense of security and perhaps permission to engage in high-risk behaviors that are harmful to themselves and others. This is much like persons diagnosed with alcohol addiction disorder believing that they can drink socially and not relapse. Persons in denial risk their medical, physical, and mental health if they ignore relevant information, behaviors, and other factors.

      The mental, behavioral, psychosocial, and medical/physical health risk and resiliency factors of individuals in the PRRC theoretical model are based on the following additional theoretical assumptions:

       The mental, behavioral, and psychosocial responses to pandemic viruses consist of healthy and unhealthy thoughts, feelings, cognitions, and behaviors that can be measured on a continuum from excellent to poor resiliency and from low to extreme risk.

       All reactions and responses during pandemic disasters are normal responses to an abnormal event. Adaptation and adjustment to mental, behavioral, and psychosocial health are dependent on the phases of a pandemic disaster and range on a continuum of risk and resiliency among individuals.

       Continuum models in general have utility for functionally measuring and depicting a range of mental, behavioral, and psychosocial health factors as well as real-life experiences of individuals, groups, and environments impacted by pandemic viruses.

       Environmental circumstances, natural supports, health disparities, racism, economic conditions, and many other cultural characteristics affect the degree of risk and resiliency experienced by individuals, groups, communities, and cultures.

       Psychological, social, emotional, cognitive, and overall psychosocial responses to disasters and trauma are based on a variety of sociocultural characteristics (e.g., race, ethnicity, geographic location, values, belief systems). Accordingly, all therapeutic interactions related to assessment, diagnosis, and treatment must be considered in a multicultural context.

       Each disaster, trauma, or critical incident (whether natural, person made, or biotechnological) has unique and defined mental, behavioral, and psychosocial characteristics. Disaster mental health and trauma response must be informed by and focused on the nature and type of the critical incident. Thus, a pandemic disaster has its own unique characteristics and traits that must be considered before implementing any therapeutic interventions.

       Adjustment and adaptation in the PRRC model are dynamic and individualized processes of risk and resiliency. They are not static, linear, or progressive. They range across a continuum of from excellent to poor resiliency and from low to extreme risk.

       Individuals may regress to an earlier level of the PRRC